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TOPLINE
Patients with localised adrenocortical carcinoma (ACC) who lived in government-designated contaminated areas had shorter recurrence-free survival (RFS) and overall survival (OS) than those who lived elsewhere, while the level of urbanisation was not linked to outcomes.
METHODOLOGY
- Researchers conducted a retrospective multicentre cohort study to assess whether living in heavily polluted areas was associated with survival outcomes among Italian adults with ACC.
- They analysed data from 336 patients with ACC (median age, 49 years; 60.1% women) diagnosed between 1990 and 2018 across 12 referral centres in Italy; 250 patients had localised disease (stages I-III; median age, 50 years; 59.2% women), and 86 had metastatic disease (stage IV; median age, 45.5 years; 62.8% women).
- Patients were grouped according to their municipality of residence at diagnosis in two ways: based on whether they resided in a National Priority Contaminated Site (NPCS), an officially designated area contaminated by high-risk industrial activity, or in a non-contaminated area and based on the level of urbanisation (city, town/suburb, or rural area).
- Outcomes included RFS (the time from diagnosis to the first radiologic recurrence) and OS (the time from diagnosis to death from any cause).
TAKEAWAY
- Among patients with localised disease, 10.4% resided in an NPCS and 89.6% in non-contaminated areas; symptomatic presentation was more common in NPCS residents (84.6% vs 54.0%), while incidental detection was less common (15.4% vs 46.0%).
- Patients living in NPCSs had significantly shorter RFS (13 vs 43 months; P = .011) and OS (67 vs 142 months; P = .016) than those living in non-contaminated areas. At 5 years, RFS rates (24% vs 45%; log-rank P = .009) and OS rates (59.1% vs 68.4%; log-rank P = .02) were also lower.
- After adjustment for age, tumour stage, mode of detection, cortisol secretion, resection status, and Ki67 proliferation index, residence in NPCSs was independently associated with worse RFS (adjusted hazard ratio [aHR], 1.89; P = .016) and OS (aHR, 2.44; P = .002).
- By contrast, urbanisation level was not a significant predictor of either outcome.
IN PRACTICE
"Environmental exposure could exacerbate tumour aggressiveness in biologically unfavourable disease. In addition, tumours in the NPCS group were more frequently symptomatic at diagnosis, which suggests a more aggressive clinical behaviour," the authors wrote.
SOURCE
This study was led by Soraya Puglisi, Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin, Italy. It was published online on September 25, 2026, in European Journal of Endocrinology.
LIMITATIONS
Environmental exposure was assessed at municipality level and data on exposure duration, intensity, or specific pollutants were lacking. The study had a retrospective design, precluding residual confounding from being completely ruled out. A small subset of patients was living in contaminated areas, and the study focused on localised disease only.
DISCLOSURES
This study received support from the Associazione Italiana per la Ricerca sul Cancro. Some authors declared receiving speaker honoraria, advisory board honoraria, and/or grant support from HRA Pharma Rare Diseases and Recordati Rare Diseases.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
